Böhm, M. et al. (2016) Non-adherence to ivabradine and placebo and outcomes in chronic heart failure: an analysis from SHIFT. European Journal of Heart Failure, 18(6), pp. 672-683. (doi: 10.1002/ejhf.493) (PMID:26952245)
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Abstract
Aims In heart failure, non-adherence increases events; in turn, the effect of hospitalization on adherence is incompletely understood. We explored the relationship of non-adherence to outcomes, hospitalizations with non-adherence, and the influence of non-adherence on treatment effects of heart rate lowering with ivabradine. Methods and results In the randomized, controlled Systolic Heart failure treatment with the If-inhibitor ivabradine Trial (SHIFT), we studied the effect of non-adherence (n = 1287) compared with adherence (n = 5204) on cardiovascular outcomes. After adjustment, non-adherence was associated with the primary composite endpoint of cardiovascular death and heart failure hospitalization (hazard ratio 3.47, 95% confidence interval 2.91–4.13, P < 0.0001). No interaction with the treatment groups of placebo or ivabradine (P for interaction 0.54) occurred. Similar results for cardiovascular death and heart failure hospitalization, as well as for cardiovascular hospitalization, heart failure death, and total death were observed. The effect of ivabradine was maintained in patients being adherent or becoming non-adherent during the trial (P for interaction = 0.54). Patients with a previous hospitalization were more likely to become non-adherent thereafter. Conclusions Non-adherence identifies a group at particularly high cardiovascular event risk independent of treatment allocation. Non-adherent patients in the ivabradine group maintain a treatment benefit. Patients with previous hospitalizations are more likely to become non-adherent and represent a group of particularly high-risk patients in whom special attention to stimulate adherence may be valuable.
| Item Type: | Articles |
|---|---|
| Status: | Published |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | Ford, Professor Ian and Lloyd, Miss Suzanne |
| Authors: | Böhm, M., Lloyd, S., Ford, I., Borer, J. S., Ewen, S., Laufs, U., Mahfoud, F., Lopez-Sendon, J., Ponikowski, P., Tavazzi, L., Swedberg, K., and Komajda, M. |
| College/School: | College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre |
| Journal Name: | European Journal of Heart Failure |
| Publisher: | John Wiley and Sons, Inc. |
| ISSN: | 1388-9842 |
| ISSN (Online): | 1879-0844 |
| Published Online: | 08 March 2016 |
| Copyright Holders: | Copyright © 2016 The Authors and the European Society of Cardiology |
| First Published: | First published in European Journal of Heart Failure 18(6): 672-683 |
| Publisher Policy: | Reproduced in accordance with the publisher copyright policy |
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